Healthcare Data Integrity and Interoperability Standards for Health Information Exchanges

as the healthcare industry moves closer to full-scale implementation of health information exchanges and integrated delivery networks the call for data integrity and interoperability standards has grown increasingly louder to help ensure that data quality isn't compromised so physicians and patients have complete confidence in the information reflected by their electronic health records the proliferation of health care electronic health records and the transition of data across health information exchanges opens the door to data corruption and as these systems become larger and more complex vulnerabilities will grow in most other industries the data integrity is just as important but corruption errors can often be rectified and mistakes fixed in healthcare it often becomes a matter of life or death one of the primary concerns with maintaining data integrity is implementing a consistent approach across the health information exchange to matching patients with their data both physicians and patients have to trust and rely that data is complete current accurate and secure escalating the complexity of health information exchanges as more networks are added and more data is fed into the system will only necessitate a concentrated effort by the entire industry to produce common standards that foster confidence data stays intact the ultimate solution to maintaining end-to-end data integrity doesn't originate from one company but must be a collective and cost effective effort from all healthcare providers across the industry we recently spoke with John Donnelly president of InterPro solutions in Colonia New Jersey and an expert in healthcare technology standards interoperability and innovation about data integrity and data standardization protocols in the context of the shift to electronic medical records and the subsequent data sharing across health information exchanges the following podcast is a recording of our conversation hi this is John Schrader wouldn't assist technology today we are really happy to have John Donnelly who the president of InterPro solutions out of Colonia New Jersey and John is here today to talk to us about data interoperability in healthcare and some other issues and just to give you a little bit of a background forever 35 years John has been instrumental in the development and implementation of information technology solutions in a variety of industries in 1994 John established an independent consulting business focused on the development and publication of health IT interoperability standards and the adoption of these standards by all levels of care provider entities and health information organizations in support of achieving the new interoperable quality based delivery paradigm commencing in 2010 John serves also as hims which is the Health Care Information Systems Society strategic advisor on the topic of healthcare interoperability throughout the world and the effect of testing and demonstration there out in national and international venues to promote innovation in the H IT solutions within the industry John also serves as the Operations Director of the New Jersey healthcare innovation Center which is a collaboration of the state's information technology University and its largest care delivery network John has also been a speaker on the subjects of healthcare technology standards interoperability and innovation at annual and Regional Healthcare conferences and also an author and publication is sponsored by the healthcare information system society better known as hims the Society of imaging informatics and medicine and also the medical record Institute as well as at conferences sponsored by medical colleges and associations for specific clinical disciplines John serves on the board of ihe international a leading standards development organization promoting health information exchange worldwide and as a lead on a number of initiatives sponsored by the HHS office of the National Coordinator for health IT known as ONC John has also been involved in a lot of different projects and initiatives that surround standards and interoperability for healthcare data and has a lot of experience in this field so we're very very honored to have John with us today to talk about this topic welcome John thank you John and thank you for that introduction it's interesting to hear some of the things that I've been involved in over here I just wanted to ask you just out of curiosity how did you land in healthcare I know based on your bio that you have experience in some other industries what what is your passion for healthcare specifically interoperability issues and how they relate to health IT well the roots of that decision actually come from the company I was working with at a time it was Siemens and and those that know the company that the German company is basically in anything that makes electronics and electricity your uses electronic electricity and how to make a decision along the career I just pick an industry that they were in and the interesting thing is that I was coming at it from the IP side and as I saw the developments of medical devices in the IT space or in the mem sorry the medical device space it became more and more apparent that there was going to be a merger of device information sourcing as well as electronic systems and replacement of paper records and and the computer and medicine just got joined at the hip this was back in in the mid 80s and with that it became kind of an immediate you know a transition for me and a passion to take that to its utmost and try to figure out how we get technology to be leveraged as much as possible in the industry great well thanks for sharing that with us what we've done is we've developed a list of questions for John and they are surrounded on the topic of data interoperability in healthcare as as most of our listeners know recently we've seen the federal government providing healthcare with initiatives to move towards more of an electronic medical record format and some of those have have been very instrumental in pushing these these healthcare providers towards more of an electronic data storage model and with the move towards electronic medical records of course there's a lot of issues that come up with data interoperability and data integrity and John being an expert we'd like to just kind of explore this topic a little bit more in-depth with him and ask him some specific questions about his opinions and his insight on where where is healthcare heading in terms of data interoperability and data integrity in the new healthcare electronic medical record paradigm we're going to start off by asking you what major challenges to hospitals and healthcare providers face as they begin to share patient data across health information exchanges and integrated delivery networks no John I think the best answer for this is to kind of split the thought into two avenues I mean if we look at it from a technical perspective or a technology perspective some of the things that come to the surface right away or one is patient identification it's not something that entities generally had to worry about outside their four walls or their enterprise now it becomes a big topic and will speak more to that I think as we talk more of it it became something that was a nonchalant thing of registration to something that that now has implications some other things in the technology area is the idea that you may have to deal with data that you didn't source so so how do you identify that and then how is that segmented in your medical record systems and and last but not least is the fact that you know data looking at our devices that we have our smartphones or tablets etc it's starting to become much more mobile more portable so how do you deal with that from the security standpoint but also an information exchange you know the other side is that kind of in the business side and there if you look at the medical professionals in the industry you know they have to deal with a new kind of patient record data ownership situation you know who does own this record if it's now been sourced by multiple people it was very easy when it was in their cabinet now it's a little different they have to look at you know maybe their way of treatment you know they have to possibly you know consider kind of a team that is an idea you know especially in primary care where they may have to have some patient treated with coordination Activision workflows that they didn't have to do and and lastly there I think what we'll see is we start to go Oh more electronic is we'll see more data analytics health data analytics being available and good health data Alex you had analytics in the past I don't think they were grounded in in really good metrics good values good numbers I think that going forward as we start to get more electronic this is what's going to help the industry with some of its decision making okay just kind of moving on a little bit with the same idea and in terms of health systems with the pressure to conform with health information exchange requirements what changes have you seen health systems make to their strategic vision of quality healthcare yeah I think for starters let's make sure we understand when we say health system what we're talking about here you know for me a health system covers all aspects of care delivery so you have your hospital you know your acute care ambulatory long-term care post acute care emergency department etc so right there you you have quite a myriad of settings you need to deal with but what we'll see is that initially it was almost a knee-jerk reaction to Meaningful Use I said that came out and everybody's health features I got to do this nobody wants to leave money on the table so you know we have to make sure we do that so that that of a sudden bubble for the surface but I think yet as they started to think through it they realize it's just a stimulus it's meant to try to motivate the industry to think differently and to change you know how they capture their their information and share it so that means from an IT standpoint they started to now look at do a good assessment of their system partners who are their partners what valuator they bring so they start to reassess that I think that they started to also look at the professionals that are serving their organization and to identify and hone a good care team you know for their specific patient populations and so they started to be able to you know how do they ensure a bond between the care team members that they want and versus others maybe that they don't feel are important and last way I think what we going to see is that they as organizations need now to really look closely at what differentiates themselves from their peers if we're in an information sharing paradigm ownership and seclusion of information is no longer the option to leverage so now you have to say well what is you know what makes me better than the next guy where are my week where am i strong okay great you mentioned a couple of things in their ownership data ownership I know is is one of the problems I I guess that arises from the birth of health information exchanges let me ask you a question though about data visibility there's been a lot of talk about the fact that moving to an electronic medical record format will allow many more patients to have access to their own medical records so that they can have more of a say in their health care more of an impact in the health care that's delivered to them I'm just following along those lines and a patient empowerment as well as on the provider side releasing information that previously main it may have been difficult to access and speaking specifically about electronic medical records how do you feel that data visibility will change the patient provider relationship well I think we have to consider that the patient now as a partner I mean so if we think of the providers role changing from the less directive and more collaborative then we're also going to see that the kind of assumed patient commitment that they have right there they assume that a patient is taking and following the medicines and the treatment that's been prescribed it's going to become more explicit I think it's not only going to be a one-sided change that the provider is now going to see something I have to change on their side I think that the patient now is going to have to understand that ownership of data or participation in data integrity means they have to step up for that it's their responsibility to help do that and I think that the at the end of the day the right direction it just means that we're going to see a much more collaborative a dialogue there and I think we saw but initially there was kind of a reaction to health information being available on the web and patients all of a sudden showed up at the doctor's doorstep with wood printouts and said you know what can you tell me about this and I think we went through that year a little bit or maybe you were still towards the end of that but now we're seeing much more provider directed web guides you know so as opposed to opposing that information resource the providers have said hey how do we leverage this but let's make sure that they're getting good information and that we can be a you know a good mentor you know – how do they do that so I do think that that it is in the right direction but it is definitely a change in the relationship probably as one of the fundamental revisions – to the environment great thank you you touched earlier John on patient identification you mentioned that previously it may not receive much as much attention or as much and as as much of a focus by health care providers as it does now how does patient identification affect data integrity and healthcare information exchange well to use someone else's phraseology here its job one I really has become critical through the process and and what we are seeing as we start to stand up these electronic environments is that prophecies that were very I was a nonchalantly handling patient registration and identification are now becoming mission-critical they are now becoming something that is the the fundamental building block for which all the data is now collected and organized and and and who has access to it and why do they have access to it and so we're seeing from a patient identification side what we might have considered as and also from the the access rights as who can see things we might see something that was a simple set of demographics and with a simple password now we're going to see things where we're going to be expecting that there's a little bit more involvement what we might call a two-factor or three factor in to use the security jargon here that that's that raises the bar of insurance that the individual that we're talking about and the individual that is interacting with this information is indeed that person and and you know ultimately when we talk to the factor we're talking things like biometrics and you know new scans and fingerprints and palm things all these stuff that that's going on and I think that that we're going to see things that are going to be a necessary component of registration processes you know one of the stories I hear all the time is when you take any of these hospital systems that are in the other cities and and in the urban areas you know there's definitely you know some names and demographics that show up repeatedly and I think there's going to be a real challenge there to make sure that that identification is right on the money you know what we see and what we read in some of the medical press is about this personalized medicine idea well you certainly don't want to be doing a personalized medicine algorithm when you really don't know that you're dealing with the same that the same exact person so you had mentioned biometrics as a newer type patient identification technology that's up that's being used by hospitals and healthcare facilities increasingly more and more are there any other patient identification technologies that you've seen in your travels or come across that you think also have promised outside of biometric patient identification I think the the only ones that I have seen that have been used is not even that far along it's more I think is what is called the two-factor where there's a token of some sort where they say a validation of of what somebody has on their person so it's not quite moved to the biometrics and that's one that I think I've seen you know be deployed as a way and you know I think we also see some processes changing if you look at the dispensing of medications in an acute care setting they now have quite a number of scans that use the the band on the patient they they have a band on the dispenser they have a band on the the provider that's that that's that's giving the Med and you know so there is kind of a way to cross-check against you know errors in terms of you know inaccurate you know dispensing of Mitch to the wrong individual so these are some of the things I think as we start to see this go more mobile I think we're gonna start seeing the leveraging of things that are happening on the smartphone and you know that that could be an easier path and even biometrics okay great thank you for all those comments um let's stop for a minute a little bit more about health information exchanges and their effects on patients obviously when you bring up the topic of a health information exchange sometimes it it it invokes certain feelings in patients that their medical data is out there for everyone to see do you see the growing importance of these health information exchanges in health care having any effect on state regulations for patient privacy and security which is increasingly becoming a hot topic around health information exchanges yeah I think it already has so that's not a future that that's the current and probably has been over the last couple of years I think for one thing I know we we always tend to lump privacy and security together as if you know their solution is homogeneous they're they're quite different but to resolve I think from from a technological standpoint and you know for me security is the easier one I mean that that's kind of can be resolved by some pretty good existing technology around standards and you know ensuring encryption and a variety of things of exchange that we can do and we do secure exchanges in other industries today so that I'm not too worried that we would be able to do secure exchanges so the security side I think is is is resolvable that the privacy one is somewhat that's a little unique to healthcare and on the privacy side we will definitely see many many dialogues around for starters the benefits of an opt-in approach versus an opt-out approaching and and and states have been discussing is now pretty heavily for the last couple of years and there are arguments on both sides and and and one seems to be coming from the deployment side saying that opting is harder to deploy but yet the opt-in enthusiasts say hey you know if we would just leverage that as a way for awareness of process and awareness of the new program to the patient and and and combine that with with that dialogue then you'll find that the very high percentage of the patients are going to opt in so you're not really at risk but we see it on both sides opt-out seems to be one that that says hey we can we can stand up something and get it going without a lot of you know upfront dialogue with the patient's which is really what we want because we want to have something to to demonstrate so if they have questions we can say hey this is an example of how we can do it but I I think we're definitely going to see legislation to try to address that challenge around that decision and the I see two things happening one we are going to have to think about state boundaries we can't be jeopardizing those patients that are living on the borders of states because one states decided to go one path another one another path that would that would be totally incent total insanity and second we have to come up with a way that we can share a consent and parent and patient preference input across those boundaries or whatever regions that need to that have providers that that are serving that patient and not have this be something that you know like we see today in the paper world where every time you go into a doctor's office you have to fill out you know another set of demographics as if you know you never wear anywhere else on this planet so so we have to do a better job of the consent exchange and but the I think we can do it it's just that it is going to take some change in some of some of it is going to need legislative change okay I know you mentioned opt-in and opt-out earlier and the answer to that previous question I'm I know that health information exchanges typically allow patients to opt out or operating in opt-out states potentially lowering the quality of data what do you feel are the primary benefits that patients should be educated on about the importance of health information exchanges well the ones that are the challenging ones are not the ones that they opt out the opt-in stage so and we have a little bit of both because the opt-in states are saying you know you can't exchange anything until they've actually had that dialogue and you've got that consent I think that the main thing here is one to ensure that the patient is aware that is happening and I think this is one of the biggest arguments that the opt-in enthusiasts have they say look we need to get the patient empowered we need to get them engaged in this so we need to make sure that they understand that this is going on and and what impact that might have on their ability to share or their providers ability to share their medical information with another provider in their interest and and even though HIPAA doesn't prevent that but says you know in the interest of care delivery they have the right to do it we're now kind of putting this the this consent component you know on top of that because we have an electronic exchange it's not you know I've seen it happen a lot of times as you automate things and then right away things that happened in the manual world you know kind of get you new visibility new attention but I do think that they're gonna have to know what's there they also have to understand that the net result of this is that it will be a better care delivery model it's it's intended to improve the care coordination they they understand I think most patients understand that that they're not treated by one physician and in their life they they have a care team that has to take care of different things and I think we're going to see more and more of that so I think the fact that we want to kind of leverage this this care knowledge across many people I think is another point of education that they need to understand and and lastly not I come back to this patient identity thing I think that the patient needs to be that control point they have to make sure that their identification is consistent across the board with their providers and you know I've heard the pushback that says well sometimes patients intentionally you know don't want to be identified that it's the same person but you know I think that's going to come back there can be an exception not the rule but I think if the patient understands how important this is that their identity that their registration information needs to be consistent and the fact that it would be available from one to the other will make that that is that a lot easier the main message in terms of what is going on I think is relatively simple and and in fact that the industry is trying to move from a sickness model to wellness model and you know that means that the patient one has to be more engaged because it's a matter of them being well not only showing up when they have a gonna have a colder or disease or procedure to be done but they are participating in maintaining their health and you know I think if they think about that I don't think we're going to see a lot of pushback with with them wanting to participate we asked you a question about health literacy John I knew that this isn't your area of expertise but I know that you have direct experience in working on issues that may of us around on the periphery that the idea of health literacy when you open up health information visa vie electronic medical records or other electronic formats to patients so they have greater access to not only their own medical records but more of a solid platform of communication with their provider or any other people within the network that are providing them care I've been reading recently about health data literacy and I guess when I'm when I'm what I wanted to ask you is there's a difference between making information available to a patient so that they can read through and understand more about their own health condition and perhaps some of others and how that may affect them but what are for our hospitals and medical facilities doing anything to help patients to understand the data I know that it's being provided to them so that they can read it but have you in your travels or conversations with other people seen any educational pushes by healthcare facilities to help patients to understand more about what their medical records actually say and how to interpret the information there John I haven't seen it at the institutional level per se except in one regard of patient portal and and you're directing a patient to a good web resource you know for information but I do know of some standards that are on the horizon that has to do with a access to a knowledge base and knowledge resource that is intended to be focused on on patient level you know of education and and and and literacy it's different than what's out there from the medical journal says you correctly indicated it it's it's intended to take this this medical jargon and interpret it into page ADIZ and what we're going to see I think in the not-too-distant future is his systems that may be a personal health record system or even systems that that might be available on the web and and with directed entry points through the provider organizations but I think we'll start to see you know lexicons around medical terminology that are able to bring it into something that that is more readable and understandable by by patients it's it's not going to happen overnight so we're going to see computer just build on this but I think it's a very important part of the idea of patient empowerment we certainly have to look at the full population mix that we are dealing with and we have to understand that we have to be able to to accommodate and get everybody up to the right level there's literacy for their needs that's a great point John one of the things that I've been reading about recently that goes along with with those great comments that you just made work was the fact that I believe that one of the theories behind moving towards an electronic medical record format for healthcare was obviously to help everyone in the aggregate but I know that often times you might find maybe a lower-income demographic or those who may not have access to their electronic medical records visa via the internet or other electronic means could benefit the most from seeing that type of information so it'll be interesting to see how the health care industry approaches that and is able to possibly set up maybe a public you mentioned portals up patient portals which are excellent sources of information for patients to read more about their own healthcare but it would be interesting to see how healthcare sort of maybe tries to reach out to that that lower-income demographic or maybe those who who don't have access to electronic means to be able to see their their electronic information their electronic medical records so thanks for those comments I know that wasn't enough something we were planning on talking about but I do appreciate you chipping in with that and let me let me kind of move on to another question and let me ask you what do you think some of the major challenges involved with ensuring data integrity and interoperability as more hospitals acquire healthcare practices in clinics so talking about mergers and acquisitions what do you think some of the major challenges are as more of these hospitals merge and and partner together when it comes to data integrity data integrity and interoperability well initially you know I say well you had the same problem that they used to have right I mean you know hospitals per se have typically had a pretty high level of automation at least in this country and you know any time they would be acquired or acquiring another system there's a pretty heavy-duty assessment of the systems and you know how do you merge the data together and things like that but but now we we see other kinds of acquisitions and partnering and that has to do with ambulatory systems coming under the wing of acute care systems and ID and etc and as a result you're now dealing with different flavors of how data is retained and the only thing I can think is that we have to now try to leverage these interoperability standards as the linchpin if if we can move the industry to having standards way a standard way of exchanging across all those boundaries then the merger and acquisition process should be a little bit easier because they should be able to have a vehicle you know to actually move a patient's information and in a more efficient fashion and and maybe they were already doing it because you know this particular entity that they acquired was one that was in their circle of friends or one that was of a medical discipline that was you know collaborative efforts for best practice development or something so I think as we start to see standards of interoperability be embraced I think that the M&A thing would actually become a little bit easier to accomplish from from a technology or or a data support side we've been speaking with John Donnelly the president of interpro solutions out of Colonia New Jersey and John is an expert in healthcare data interoperability issues especially with the new shift for the healthcare industry towards electronic medical records John I want to thank you for your time today I appreciate all of the feedback and insight that you gave us on the questions that we had for you and we really just appreciate you spending some time with us today John my pleasure I think as we all become quite passionate in how do we make this transformation work for us all I say could be be a fun ride but one with some challenges as well you

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  1. Mistakes in data and information as this video says can be the difference between life and death.

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